Transitional care programs: who is left behind? A systematic review.

Area of Science:

• Gerontology
• Health Services Research
• Clinical Trials

Background:

• Older adults face significant rehospitalization risks due to fragmented hospital-to-home care transitions.
• Effective transitional care interventions are crucial for improving outcomes in this demographic.

Purpose of the Study:

• To evaluate if randomized controlled trials (RCTs) of transitional care interventions adequately represent older adults at high risk for rehospitalization.
• To identify common risk factors for rehospitalization examined in these RCTs.

Main Methods:

• A systematic review of RCTs focusing on hospital-to-home transitions in older adults.
• Inclusion criteria required interventions with pre- and post-discharge components and a self-care element.
• Exclusion criteria included mean participant age under 55 or interventions not relevant to general older adult populations.

Main Results:

• Seventeen articles met the inclusion criteria after a systematic review.
• Key risk factors for rehospitalization (e.g., cognitive impairment, polypharmacy, comorbidities) were frequently exclusion criteria or not reported.
• Only one study included patients with all identified high-risk factors.

Conclusions:

• Published RCTs on transitional care interventions may not include the oldest and most vulnerable patient populations.
• This lack of representation raises concerns about the generalizability of findings to those most in need.
• Future research should focus on interventions specifically designed for older adults at the highest risk of rehospitalization.